Specialty Case Management

Overview Facts

  • Targets High-risk, High-cost and Complex Specialty Care
    • Real-time identification via:
      • Utilization Management
      • Maternity Management
      • Chronic Condition Management
      • Predictive Modeling of Medical & Rx Claims
      • Biometric Screening and Health Risk Assessments
  • Collaborative Process to Assess, Plan, Implement, Coordinate and Monitor Care
    • True patient advocacy including education, support and alternative funding assistance
    • Assist Payer in determining member prognosis and projecting future treatment costs
    • Comprehensive Case Management notes
  • Access to National Centers of Excellence and Transplant Networks
  • Experienced Registered Nurses and Physicians with both Specialty and Case Management Certifications
  • Specialized Case Management
    • High Risk Maternity
    • Preterm Infants
    • Transplants
    • Oncology
    • Multiple Trauma
    • Rehabilitation
    • Hemophilia

Program Impact

  • Maximize Stop Loss Discounts
  • Ensure the Right Care, at the Right Time in the Right Setting
  • Contracted and Negotiated Savings for the Plan and Member